Neuroworsening in Traumatic Brain Injury: A Scoping Review of Definition, Prevalence, and Outcome.

Background: Neuroworsening (NW) refers to a state of deterioration of neurological status that occurs as a consequence of the progression of primary lesions or due to intracranial or systemic complications. NW has been associated with worse functional outcomes, and therefore its avoidance may improve prognosis. The objective of this scoping review was to analyze the definitions, prevalence, predisposing factors, and impact on the outcome of NW during all spectra of traumatic brain injury (TBI).

Methods: We performed a scoping review following Joanna Briggs Institute guidelines.

Results: A total of 92 studies were identified after the systematic review of the literature using four databases. After applying Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 19 studies were included in the final analysis. Criteria used to define NW were not specified in ten studies, two studies used clinical criteria, two used radiological criteria, and five used a combination of clinical and radiological criteria. The mean prevalence of NW of the total population was 17%; whereas the mean prevalence was 28.2% for severe TBI, 23.4% for moderate TBI, and 6.42% for mild TBI. The predictors of NW were multiple, with a predominance of neuroimaging findings.

Conclusions: NW is common after TBI, occurring in one in every five patients, and it is associated with high mortality and worse functional outcomes. The criteria to define NW has varied across studies; most used definitions based on clinical and neuroimaging criteria, but some included neuromonitoring parameters. Thus, lack of uniformity in the definition of NW remains a major limitation for the study of this major complication. A consensus to standardize the definition of NW and large-scale studies to determine its prevalence and risk factors are urgently needed.